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Doctors are being urged to avoid using "undesirable terms" such as "fatness" or "obesity" when broaching a discussion about excess body fat with their patients.

"Use of such terms may offend or distress some patients and prevent them from continuing to discuss their weight," say researchers who surveyed 390 obese patients in the Philadelphia area and asked them to rate words they found the most, and the least offensive for describing their excess size.

Other undesirable descriptors patients offered up included "you are way too fat" and "you are lazy."

The words "obese" and "fat" too often carry negative and demeaning connotations, the study's authors write in the journal, Obesity.

"Very few physicians - sometimes I've seen numbers as low as 12 per cent - counsel their obese patients to lose weight," said lead author Sheri Volger, project manager at the Center for Weight and Eating Disorders at the University of Pennsylvania's Perelman School of Medicine.

"By identifying how patients prefer to be talked to, we're hoping to facilitate the dialogue."

The new work was part of a larger weight loss research study. All 390 participants were patients at six primary care practices in the Philadelphia area.

Before treatment, each completed a questionnaire asking them to rank, on a scale of one to five - "from very desirable" to "very undesirable" - 11 terms a doctor might use to describe weight: weight, heaviness, obesity, BMI, excess weight, fatness, excess fat, large size, unhealthy body weight, weight problem and unhealthy BMI.

"Fatness" was rated the most undesirable of all. "Excess fat," "large size", "obesity" and "heaviness" were also ranked significantly more negative than the remaining terms, the authors write.

The preferred term was "weight" - perhaps because it's more neutral and non-judgmental, according to the researchers.

The surprise was that even "obesity", which is a medical term, was almost as universally disliked as "fatness," Volger said.

"Obesity" isn't neutral, she said. "It's judgmental and it has negative attributes ... You're imposing blame on the person; the thought may be that this person is obese and that they're at fault for the situation."

"There's a bias against obese persons, and it's not limited to the lay public," she said.

Prejudices have been reported among nurses, doctors and even those who specialize in the treatment of obesity.

Discussions about weight should be framed around other health issues, Volger said, without putting people on the defensive "and making them feel like they're a failure."

"You could say something like, 'Mr. Jones, nice to see you today, I see your blood pressure is a little high. I also noticed you're 10 pounds overweight. Do you know if you lost some weight your blood pressure could go down?' "

The findings come as Canada's leading obesity organization - the Canadian Obesity Network - prepares to release recommendations to doctors on managing obesity that will advise doctors seek permission before even raising the issue of excess weight or offering any advice, and that any such discussion be done in private, said Dr. Arya Sharma, the network's scientific director.

"There is no room for shame or blame in obesity management," Sharma said.

One quarter of adults in Canada, and about nine per cent of children aged six to 17, are now obese, according to a joint report released last summer from the Canadian Institute for Health Information and the Public Health Agency of Canada.

When figures for obesity are combined with those for being overweight, 62 per cent of Canadians overall weigh more than they should.

And the heaviest weight classes are growing the fastest: The proportion of adults falling into extreme, or Class 3 obesity, meaning a body mass index of 40 or more, has increased threefold, from 0.9 per cent of the population in 1978-79, to three per cent by 2009.

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